THE FARCE AND THE FARCEUR

The film opens in the early years of the 20th century with Knock, the aspirant to a medical practice, sitting in the back of an old jalopy—what the French used to call a torpédo—with Doctor Parpalaid and his wife. Knock has just purchased Dr Parpalaid's practice in the small town of Saint-Maurice, which, from the references to hilly country and the nearby presence of Lyon, would seem to indicate a sleepy hollow somewhere in the French Alps. Somewhere deep in dear old France. All the business has—unusually—been concluded in advance by letter, and Knock is exercising his right to be introduced to the clientele. Dr. Parpalaid is a decent old duffer—un homme de l'art as the French used to say of their doctors, or a man of “good intent” in Romains's term; his wife a formidable matron with a better sense of business than her husband. They have decided, after careful consideration, to move on to better things in Lyon—she has rheumatism and her husband “swore he would finish his career in a big city”. Urban aspirations notwithstanding, they extol the virtues of the canton to Knock: a railway far enough away for the clientele to stay put, no competitor, a chemist who doesn't try to do the doctor's job, no major overheads. Knock seems uncommonly interested in what kind of diseases his prospective clients might suffer from, and is put out to discover that the local people generally come “only for a single consultation”. There are no regular patients: it's not like the baker or the butcher, exclaims Madame Parpalaid, who takes him for a bit wet around the ears. Knock is forty, Faust's age; though he admits to having completed his thesis only the summer before: Sur les Prétendus états de Santé (On Imaginary States of Health), with an epigraph from Claude Bernard: Les gens bien portants sont des malades qui s'ignorent. Well people are sick people who simply don't know it—yet. (I Bamforth, Knock [English translation], unpublished document, 1999) It is a motto about the unwitting patient in all of us, and it turns out, ominously, to be the most telling line in the play.

There are already some subtle worrying signs about Knock. He doesn't know the church feast days, not even Michaelmas, which is when Dr Parpalaid's patients are in the habit of paying him. (Dr Parpalaid has roguishly sold the practice just after this date, thus giving Knock grounds for accusing Parpalaid of attempting to fleece him—but when did a doctor ever buy a practice without seeing it first?) As a child he was apparently an avid and precocious reader of the information slips tucked around bottles of pills: at nine he could recite entire pharmacopoeias of side effects. He has already been a ship's doctor, he informs Madame Parpalaid, and for the duration of the voyage had crew and passengers confined to the sick bay: only the expediency of a roster kept the ship manned and the engines running. In short, Knock has a vocation and no ordinary one at that; and he has a “method”.

Knock arranges for the other members of the cabal, the teacher and the pharmacist, to visit him. His language is fulsome and ingratiating. He bludgeons the former with the modern horror of microbes. As physician-magus, he consigns the latter to the role of marchand-épicier, one of those money-hungry apothecaries and suppliers of unicorn's horn who inspired Molière to create Purgon and Fleurant. He engages the town crier to tell the country folk that consultations are to be given free of charge at the surgery on Monday mornings. When he asks the town crier what the townspeople used to call his predecessor, he discovers it was never “Monsieur le docteur”, but often a soubriquet—Ravachol. Romains is enjoying a little joke with his audience. Ravachol was a notorious anarchist in nineteenth-century France (his actual name was Kknigstein) who ended up losing his head to the guillotine. His name marks Dr Parpalaid out as an old-fashioned believer in anarchism as against the power of capital and the state, though it has to be remembered that nineteenth-century anarchism was not irrationalist: it was utopian. It is an attitude still quite common among French doctors who, rather than acknowledge the unwelcome fact that doctors need the state to protect their monopoly, champion what they call “liberalism” as a solid defence against the intrusions of government into private life. Romains defined his philosophy of unanimism as “a natural and spontaneous harmony within a group of people who share the same emotion”. The very fact that Kropotkin's cooperatives and Proudhon's theory of “mutual aid” derived from Darwin's law of natural selection as effortlessly as did Spencer's competitive model, which provided a foundation for eugenics, suggests there can be no straightforward leap from scientific to political ecology. Indeed, this kind of anarchism—of the non-bombing, moralistic kind extolled by Tolstoy—looks mostly like a philosophy for smallholders.

All this is old hat to Knock. His ideal of social organisation is a form of hygiene organised around himself as “continual creator” and saviour. His plan for conquest is clearly of long standing and carefully organised. He assiduously acquaints himself with the incomes of his clients. Patients are ruthlessly stripped of their defences, beginning with the flimsy mantle of insouciance which has protected them from worrying about their health. The Lady in Violet, a certain “dame Pons, née demoiselle Lempoumas”, gets the shock treatment: her insomnia, which Dr Parpalaid had never taken seriously—he used to tell her “to read three pages of the civil code every evening”—may now be the result of a “pipestem deformity” of the intracerebral circulation or perhaps even a “sustained neuralgiform crisis of the substantia nigra”. Or perhaps, as Knock quickly adds, it's just a big black spider sucking on her brain.

Knock's use of “big words” to terrorise the Lady in Violet is one of the oldest medical tricks: think of Molière's cod Latin-spouting Sganarelle in the most famous predecessor farce le Médecin Malgré Lui (1666), or the nuciform sac, a structure unknown to any anatomy textbook but wielded to good effect by the surgeon Mr Cutler Walpole in George Bernard Shaw's play The Doctor's Dilemma (1906).⁵ The description of Walpole in Shaw's stage directions even resembles Jouvet's portrayal of Knock in the film: his face, according to Shaw in his stage directions, looks “machine-made and beeswaxed; but his scrutinising, daring eyes give it life and force. He never seems at a loss, never in doubt; one feels that if he made a mistake he would make it thoroughly and firmly...”. It may be scandalous to admit it, but dissembling has long been part of medicine's therapeutic arsenal: Knock proffers big words, not for the sake of the cure, but for the rather more pertinent issue of reinforcing his authority.

The nuciform sac turns up in another guise in Axel Munthe's hugely successful if self-regarding volume of reminiscences from the same decade, The Story of San Michele (1929), in which he tells how, when working in private practice, the fashionable diagnosis of colitis, invented precisely to save patients from the scalpels of surgeons like Mr Cutler Walpole, “spread like wildfire all over Paris”.⁶ Munthe, a young Swede who qualified in Paris at the unheard-of age of twenty-two, was once called “the most fascinating man in Europe”: his persuasive bedside manner brought him a large clientele of largely wealthy patients whom he believed should be made to pay for the poorer (Knock has a system of “means testing” too). Several chapters of Munthe's memoir are devoted to the most famous doctor of his time, Jean Martin Charcot, with whom he trained at the famous Paris hospital La Pitié-Salpêtrière. Patients, doctors (most notably Sigmund Freud, in 1885), and the public flocked to see the great man in action in his auditorium where his mostly but not exclusively female patients famously arched their backs at the critical moment of hysterical suggestion. Charcot took hypnosis seriously as a technique for healing, though the psychoanalytic movement as a whole, fearing that transference and countertransference would contaminate the psychoanalytic method, shied clear from suggestion techniques; even then, was to stay in the bag of tricks of many an individual psychoanalyst. Munthe's thumbnail sketch of Charcot speaks volumes for the magical function of the medicine man in an age that proclaims itself thoroughly rational. The following passage was actually omitted from the French translation of San Michele, presumably because its hint of diabolism failed to flatter the reputation of the Maître who had dominated French medicine for more than a generation: “Charcot for instance was almost uncanny in the way he went straight to the root of the evil, often apparently only after a rapid glance at the patient from his cold eagle eyes”.

Once Knock has made it explicit, danger is like the house-dust mite: everywhere. One might call it “Getting the Fear”. Knock encourages the local schoolteacher, Mr Bernard, to indulge his little obsessive-compulsive tic—”Do you think, doctor... I may be a carrier of germs?” Mr Bernard's phobic reaction testifies to the power of a mystery—the invisible germ—caught in the full glare of scientific explanation. No other scientific figure stands with such emblematic clarity in republican France's sense of itself as the bacteriologist Louis Pasteur—“le bienfaiteur de l'humanité”. It was after all the French Revolution which gave rise to the belief that where a physician worked his miracles there could be no clergy, and that illness was a matter for the common weal. The evil of profiteering doctors would disappear once equality, freedom, and fraternity had been established. Diseases would be classified; statistics collated; clinics built. Pasteur is emblematic because he embodies so well the due process of the positivist formula: theoretical research plus application of acquired knowledge makes for general wellbeing.

Medicine, for the nineteenth-century French, was the advance post of Progress. Such was its prestige that Zola made his novels case-histories: he anticipates one of Knock's lines in his novel Lourdes with the query: “Supposing that after all there is a Power greater than that of men, higher than that of science? It is the instinctive hankering after the Lie which creates human credulity.”⁷ In Zola's literary-lab view of the world, pharmacy is on a level with semiology. While flattering Mousquet, the only chemist in town, Knock astutely promises to triple his income within a year. Besides, aren't they partners in the great fight against disease? When Mousquet points out that people have to fall ill first, Knock retorts with a policy statement: “`Fall ill'—that's an old-fashioned idea! It has been completely overhauled by modern scientific medicine. Health is a word which could just as well be struck from the dictionary. What I see are people variously affected by a various number of diseases of varying virulence. Of course, if you insist on telling them they're well, they'll be only too happy to believe you. But you're leading them on. Your only excuse can be that you already have too many patients to take on new ones.”

So effective is Knock in medicalising the town that when Dr Parpalaid returns three months later to collect the outstanding payment for the sale of the practice, he finds the local Hôtel de la Clef full of patients. The chambermaid (now nurse assistant) fails to recognise Dr Parpalaid and innocently insults him by adding that she hadn't known there was a doctor in town before Dr Knock. Mousquet is run off his feet with work, and loving it: “it's not the old cabbage patch life of the old days”. Mr Bernard, the schoolteacher, has moved on to giving illustrated public lectures on the need for perpetual readiness against the menace of the microbe. Public health was a major concern in the Fance that had lost ten per cent of its male population to the first world war: even Louis-Ferdinand Céline—aka Dr Destouches, urban nihilist and Proust's closest rival for the title of the greatest French novelist of the century—did his stint to improve the stock of future generations, touring Brittany in a Rockefeller-funded campaign against tuberculosis in the period in which Knock was written, when he would sing, to presumably startled schoolchildren, “va-t-en, va-t-en microbe!” to the tune of “Il pleut, il pleut, bergère.” (These campaigns against the unseen menace in the midst of the French population evidently had an effect, as can be surmised from the habits of an unquestionably intelligent middle-class family of the period: Simone Weil's biographer reports that her entire family, in the 1910s, lived in fear of microbes, obsessively washing hands, opening doors with elbows and generally shunning physical contact.⁸)

Knock astounds his predecessor with his figures for the last three months, and not just the consultation rates: he knows the incomes of every household in the canton. But it's not their money he's after, he assures Parpalaid: he has brought people to medicine, he has given their lives a medical meaning. In the long monologue at the end of the play he introduces the pathos of 250 households où quelqu'un confesse la médecine, not to mention the climactic prospect of 250 rectal temperatures about to be read simultaneously. He asks Dr Parpalaid to reconsider the view out of the practice window:

You were contemplating a wild landscape, barely cultivated by human hand. Now I offer it to you impregnated by medicine, fired by the spirit of our subterranean art. When I stood here for the first time, the day after my arrival, I wasn't too proud: I realised my presence didn't count for much. This vast expanse of France had the temerity to spurn me and my coevals. But now, I'm as much at ease here as an organist sitting down to play his instrument. In two hundred and fifty of these houses—not all of which are apparent because of the distance and the greenery—there are two hundred and fifty bedrooms where someone's confessing the power of medicine, two hundred and fifty beds where a recumbent body attests that life has a purpose, and—thanks to me—a medical purpose. At night the view is even more beautiful, for then their lights shine out. And almost all these lights are mine. Non-patients sleep in the outer dark. They cease to exist. But patients leave on their night-lights or their lamps. For me, night banishes everything that remains outside medicine, wipes away its irritation and provocation. Instead of the district we know there is a kind of firmament of which I am the continual creator. And I haven't mentioned the bells. Their first office for all these people is to call them to my prescriptions; the bells intone my orders. Think of it: in a few moments, ten o'clock is going to sound, and for all my patients ten o'clock is when they read their rectal temperature for the second time: just think, in a few moments, two hundred and fifty thermometers will be inserted at the same time...

Knock is acting not in his own good, he tells Parpalaid, nor even that of his patients, but in the interests of that third thing: la médecine. Parpalaid is struck dumb, bereft of argument. There can be only one possible conclusion: soon the old doctor, who has already had to suffer the ignominy of his less than rapturous welcome by the hotel/hospital staff, and who would seem the person best armed through his culture and experience to recognise Knock for what he is—an agent of the great lie—and thereby resist his blandishments, is being invited by his successor to take a rest cure himself. Knock's medicalisation of the canton is complete.

Progress has come to Saint-Maurice, so it believes, and it is a collective progress which nobody has the power to resist, not even Dr Parpalaid. A self-contained society forms as the spectator watches; it shares the same hopes and fears, its solidarity is such, even after three months, as to repulse Dr Parpalaid when he comes to collect the remainder of the payment on his old practice. Whatever fails to fit this world-as-interpreted-by-medicine is suppressed or rejected: medicine for the inhabitants of Saint Maurice becomes the very content of their lives. They offer Knock a seller's market. He leans on what he is expert at inducing—fear: a contrived dart of panic among the cast that can make laughter from the auditorium sound oddly complicit or uneasy. The inhabitants of St Maurice might be suffering from maladies imaginaires, but Knock is a master at the art of reinforcing that particular form of fright. His strategy is simple but effective: he defines the bad, and dictates the good. He invokes a cosmic principle, subjecting the horizontal society of supposedly autonomous subjects to the vertical idea—of divinity. Perhaps he is a latter-day Dr Mesmer, a magnetiser who puts the instruments of reason to the ministry of what is essentially a prospect of salvation, plumbing that part of the mind that is ineducable, a metaphoric but no less fateful terra incognita the French psychologist Pierre Janet termed “the subconscious” five years before Freud.

HYGIENE AND POLITICS

What gives pause in Romains's brilliant farce is that, in the 1930s, that politicised and polarised decade, Knock was interpreted as a parable about demagogues able to capture the public imagination and mould entire populations to their will. Knock was a type of Great Dictator, the politician without principles: 1922, the year before the play was written, was also the year “Il Duce” came to power in Italy.

There are parallels. The more daringly absolute Knock's demands on the Saint-Mauriciens—he even gets the Lady in Black, who exudes “peasant avarice and constipation”, to renounce what is clearly her only real passion in life, la bouffe—the more certain they are of his authority to impose such strictures upon them. Their microcosm, even though it is rural, has no socially cohesive institution to counteract medicine's explaining power (hence Knock's interest in Act I in discovering whether the townspeople go regularly to Mass, white or black). Knock lacks any sense of scruple or limit, though he repeatedly claims he is the servant of a higher morality. He plays up to his patients' amour propre, while drastically curtailing their freedom. Sacrifices there will have to be. Soon his patients are running after something they already have. Mark Twain noted, with his usual pawky humour, how little of substance is actually offered by health messiahs: “There are people who strictly deprive themselves of each and every eatable, drinkable and smokeable which has in any way acquired a shady reputation. They pay this price for health. And health is all they get out of it. How strange it is. It is like paying out your whole fortune for a cow that has gone dry.”⁹ Or it could be that Knock is in thrall to an impersonal will-to-diagnosis: in the last scene of the play he tells Dr Parpalaid that his “involuntary diagnosis-making” has become so highly developed he dare not look in the mirror. Not, at any rate, with his tongue in his cheek.

Romains was surely aware of Nietzsche's visionary portrait of the “great deceivers”, written forty years before his play: “The point of honesty in deception: In all great deceivers there takes place a remarkable process to which they owe their power. In the very act of deception with all its preparations, the dreadful voice and face and gestures, amid the whole effective scenario, the belief in themselves overcomes them; and it is this belief which then speaks so miraculously, so persuasively, to their audience... . For men believe in the truth of all that is seen to be firmly believed.”¹⁰

In 1923, Knock's claims to effectiveness were mostly laughable. The farce was still a game. Medicine lacked sufficient prestige for its authority to be recognised as a law of nature, as Simone Weil, pointed out in her essay The Power of Words. She comments specifically on the power of institutions to “secrete” abstractions: “This particular kind of secretion is wonderfully illustrated by Jules Romains' Knock with his maxim: `Above the interest of the patient and the interest of the doctor stands the interest of Medicine'. It is pure comedy, since the medical profession has not so far secreted such an entity.”¹¹ Not so far? Exactly a decade later German doctors were among the most enthusiastic supporters of the social mutations of Hitler's New Republic, servants of a Medicine whose aims were ideological, over and above the interest of individuals. Doctors were feted as warriors in white coats, for National Socialism was nothing else but “applied biology”. The Nazi ethos was actually based on a sacred biology, its internal logic consistent with the Nazi belief that the party had been ordained to shape the world's destiny, a destiny which itself would be biological. Science wrote the libretto, Wagner provided the orchestration. Robert Proctor's recent study of public health policies during that period categorises Nazism as “a vast hygienic experiment designed to bring about an exclusionist sanitary utopia”¹²: paranoia about contamination and pollution wasn't just metaphorical, but served as a literal spur to concerted attempts at engineering the health of the German population. Studies were launched into environmental hazards, and efforts were made to improve the German diet and reduce alcoholism. Hitler, as everyone knows, was a non-smoking teetotaller. The Nazi example is extreme, but it reveals the thinness of the line between individual liberty and public compulsion: in a sense, public health is medicine's “original sin”, subverting its proper concern with the individual that has come down from Hippocrates.

But would we be without public health and decent living conditions? A Times editorial of 1854 thundered at John Snow's attempts to introduce better quality drinking water and sanitation in the Broad Street area of 19th century London: “We prefer to take our chance with cholera than be bullied into health”.¹³ How many club members folded up their newspapers, one wonders, and wandered down through Soho to Broad Street so that they might take a drink directly from the source?

KNOCK AND THE FUTURE

After the war, Romains's prescience about the great dictators was acknowledged in the breach, though any comfort it might have brought him—vilified in the collaborationist press, witness to the disgrace of France and deprived of the moral support of his friend Stefan Zweig, who committed suicide in 1942 in Brazil—must have been slight. Cold-war Europe was no longer the continent he had striven to save. He ended his days, some of them at least, in that famous retirement home for distinguished Frenchmen, the Académie Française.

It was left to Louis Jouvet, in an article published to conclude a conference at the Université des Annales in 1949, to show how well he understood the ambiguous appeal of the play and its eponymous character: “Twenty-five years ago, in a penetrating act of inspiration, Knock revealed the direcrtion a new mentality was going to take... . This mentality was Information and its strategies, astounding advances and violent dramatisings; abrupt and terrifying revelations; the invention of new needs, new ways of breakdown; the exalting of fresh anxieties that humankind would feed upon. Jules Romains announced, though we didn't yet know it, the mad-cap mechanisms that were going to rule the world, suggestion and self-suggestion. In Knock, like a prophet at the gates, Jules Romains suddenly shone a light on power, the upsurge of parodigms (idées-forces) and collective theories. Humankind is a machine to make gods and every leader of men a creator of myths. Jules Romains, philosopher, moralist and dramatist, provided an admirable advance warning of the modern and all-encompassing mechanism of cohesion and conviction...”¹⁴

Romains's play is still read and studied by French schoolchildren, which is cheering. But it seems to have had little effect as critique on the original experimental society: France is now one of the most highly medicalised countries in the world. The postwar period saw the medicalisation of France in the grand style, a process dramatically accelerated by the events of summer 1968. “Knockisme” has entered the French language, and is used occasionally in medical anthropology as a descriptive term for popular credulity and gullibility.¹⁵ Yet the play is more than a study of dupery: the Italian philologist Guido Ceronetti noted that all the old satires on medicine and doctors (and there is no shortage in French literature) look backwards, over their shoulder; Knock, on the other hand, steps confidently into the future.¹⁶ It is a play that capitalises on Marx's idea of tragedy reinstated as farce—except that the farce comes first and the tragedy later. The villain of the piece allows himself a smile just once in the play, while reading the town crier's mind. He has made a discovery, and it isn't medical, but mythic. In the “Big Lie”, according to Hitler, there is always a certain force of credibility. Knock has found a way to deflect hubris. By deflecting it from himself, he obliges Nemesis to visit those who take him at his word. Nemesis is user-friendly and not at all dramatic, ladies and gentlemen, for these are modern times—Nemesis is the realisation that desire is both prerational and manufactured to the highest quality standards. Nemesis is the actor acted upon. Just look around. Despite all our best efforts illness refuses to disappear. It takes on new forms; it turns up where nobody left it; it gets invented by the political and social relations of civilisation itself, which includes the medical profession. Then the misfortunes to which doctors owe their livelihood—illness is, at least, a natural evil—become morally ambiguous. People start to visit the doctor not so much because they are ill, but because they can't be healthy. Soon doctors start to resemble lawyers, who also owe their livelihood to an evil, but not a natural one. And before we know it, we are opening the door on the world of Knock's higher cynicism: with his right hand he accepts the fee for stilling the devil he set loose with his left...

But that left hand has created a community of interests. Knock treats the people of Saint Maurice coldly, like an anthropologist. He simplifies what he says, then he repeats himself. Isn't it that people ask to be deceived? All right, he will deceive them. Order requires domination, and domination requires a lie or two. So he gives their lives a medical meaning. That is: he extends the bounds of the biological, of whose oracles he is the interpreter, so as to make illness not just a bodily phenomenon but an organising principle for the effective administration of society itself. His argument is life, for that is what a doctor defends. His tools are ideals, seduction, fright, and, if necessary, the threat of violence. His power is his command of language; in that respect nothing has changed since Molière's day: Knock is every bit as much a storyteller, raconteur, bluffer, salesman and “habile homme” as Sganarelle, who was a subversive valet and sham doctor. But who's talking sham? Knock gives everyone the fever. He inoculates his patients with the one idea: self preservation, at all costs. And even more disturbingly, as Nietzsche's insight suggests, he might not be a cynic at all: he might be the Lie in person, someone who lies not, as it were in the detail but in his very mode of existing.

We have to go back to the beginnings of Enlightenment and the twilight of the traditional world from which doctors derive their magical aura as healers to find out why. The first realisation that the equation “knowledge is power”—Knock's equation—could turn in on itself, through the force of imagination, is to be found in the work of one of the wittiest and most perspicacious philosophers of the Enlightenment, Georg Christoph Lichtenberg (1742–1799). Around the time of the French Revolution, that historical rupture that changed the role and status of the medical profession for better and worse, he wrote a short but pregnant aphorism. “Health”, he told his scrapbook, “is contagious”.¹⁷